This week’s guest has led something of a double life, using both medicine and the media to explore and promote the critical role of evidence in healthcare. Now based at the University of Sydney, Alexandra Barratt's journey from clinician to journalist to global advocate for evidence based medicine and shared decision-making is a fascinating one.

Here she talks with acclaimed journalist and health researcher ,Dr Ray Moynihan, about her varied career and the reasons she's ended up challenging conventional wisdom. She also talks about her research into the pros and cons of breast cancer screening and questions the widely-accepted idea that early detection is always the best medicine.

Swiss illustrator explains his motivation for creating the comic and what he hopes it shows.

The World Health Organization (WHO) has issued new recommendations to establish global care standards for healthy pregnant women and reduce unnecessary medical interventions. The new WHO guideline includes evidence from 17 Cochrane Reviews and has 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.

Swiss illustrator, Martin Vuillème from The Science of Cookies (an online French-English comic about the health and social sciences, research, and news) created a comic about the many steps involved in updating the WHO guidelines on the childbirth experience. Here he explains his motivation for creating the comic and what he hopes it illustrates:

“Pregnant women all over the world are keen to make the best decisions for their children and for the future of their families. This may lead them to hear various advice and suggestions from doctors, nurses, midwives, friends and relatives, or even from people they meet on the streets. But where do reliable recommendations come from? What are they based on? And why should we trust them?

In this illustration I wanted to point out the tremendous work of WHO and the extreme care that was put into formulating trustworthy health recommendations. From the selection of a diversity of unbiased guideline authors, the prioritization of the most important questions and outcomes for pregnant women (such as a “positive childbirth experience”), the search of the most reliable evidence (often coming from Cochrane, an important partner of the WHO) up to the formulation of the final recommendations and their dissemination I hope to have captured the essence of key steps involved in the creation of helpful, informative and reliable international recommendations.

While I may have decided to summarize the guideline making process to a couple pages, care should be taken not to forget that the WHO recommendations and Cochrane review that inspired the creation of this illustration are the culminations of years of efforts invested by dozens of international experts (among which the critically important pregnant women representatives!)...But most importantly, they are the fruit of respectful discussions informed by values and based on research involving thousands of pregnant women, who often volunteered their time and sometimes even risked their lives in the process with no direct rewards. The WHO and Cochrane authors couldn’t have done their work without them.

The care, consideration towards pregnant women and rigor that were shown in the making of those recommendations are the reasons why I put my trust in Cochrane and the WHO...And the reasons why I plan to continue doing so in the future.”

The comic is currently being working on and the input from those involved is welcomed. We will update this page as it progresses.

Editor in Chief of the Cochrane Library, David Tovey, describes the journey of updating the Cochrane Library, which spans being a journal and a knowledge resource, and includes current and archive content, multi-lingual text, and a varied collection of databases.

It all began in April 2012 at Cochrane’s business meeting in Paris: a ‘strategic session’ aimed at agreeing a content strategy for Cochrane and our primary output, the Cochrane Library. My team had prepared well: there was broad approval for moves towards greater diversity in content, and more flexibility in its presentation and delivery to end users (readers). If that moment represents conception, it has been an awfully long gestation.

Readers less familiar with Cochrane may be uncertain about what constitutes the Cochrane Library. Is it a journal? Is it a knowledge database? Therein lies some of the complexity. The Library is a collection of knowledge databases. One of these, the best known and most used, is the Cochrane Database of Systematic Reviews (CDSR). This contains some 7600 systematic reviews, published over the past 25 years, many of which have been updated several times. The CDSR is also a hybrid journal containing some open access content and some available via subscription, which is largely organised on a national, regional or institutional basis. It has monthly issues, an impact factor, and is heavily accessed and cited. The Cochrane Central Register of Controlled Trials (CENTRAL) is a concentrated collection of (predominantly) randomised controlled trials, curated from a variety of sources. It is an essential part of the search for all high quality systematic reviews, whether produced inside Cochrane or not.

The recommendations that emerged from the Paris meeting formed the basis for goals 1 and 2 of the subsequent Strategy to 2020: to produce high quality, relevant reviews that inform health care decision making and to ensure that those reviews are accessed and used. The work to deliver on these goals can be tracked forward to our current Transformation Programme, which has brought together our 52 Cochrane Review Groups into 8 thematic Networks, and the development of our Content and Knowledge Translation strategies. These all reflect an awareness that our content needs to meet increasingly diverse and sophisticated decision maker needs and reflect emerging methods and data sources. We also need to find different ways to communicate review findings, based on a range of different user types (‘personas’ in tech development-speak), and including more diversity in language, presentation (or ‘packaging’) and delivery.

Fast forward from Paris to the café at the Novotel, Hyderabad in September 2014. Around a table in the late afternoon during the Cochrane Colloquium, Todd Toler and Deborah Pentesco-Murphy on behalf of our publishers, John Wiley and Sons laid out their proposals. In essence, after many frustrations, we all recognised that the Wiley Online Library platform, which had hosted the Cochrane Library for many years, was not able to accommodate Cochrane’s plans, without undermining its ability to host all Wiley’s other journals. We agreed that the solution was for Cochrane to be hosted separately, at Wiley’s expense, on a new platform, which would be identified through an RFP (Request for Proposals) process. The discussion energised us all, and it was not difficult to get clearance from our Governing Board to proceed. We had a plan.

A few months later, the venue is a Business School residential centre near London. The largest interview team I have ever experienced – seemingly about 20 people in the room, with more on the phone. Two of us from Cochrane. Four candidate teams over two days. Two clear leaders, and an eventual winner: a software company called Semantico, based in Brighton.

The development was meant to take 12 months. Six or seven months in, we were already behind schedule, when in a blink of an eye Semantico ceased to exist; acquired by Highwire a platform technology company based in Stanford USA with encouraging experience of having hosted major international journals. It may seem churlish now to point out that one of the influences in our choice of development partner was the personal commitment from Semantico’s founder and owner to stay the course. As it turned out not only did Semantico cease to exist but so did its entire Senior Management Team – submerged below the surface without so much as a ripple. The Semantico project manager, then and now viewed widely on all sides as one of the many unstinting heroes of the project, provides the only visible continuity, apart from the developers.

As time went on it became increasingly clear that our deadlines were not being met. The tri-partite development approach originally agreed by Cochrane, Wiley and Highwire was severely tested – we always knew that it was the greatest risk to the project. We got further and further behind schedule despite everyone’s best efforts, which were considerable. Our Governing Board looked over our shoulder, expressed its concern, but permitted us to proceed.

Most of us have had to familiarise ourselves with a new language and new processes. This is a world where ‘waterfall’ is an alternative to ‘agile’. Everyone seemingly agrees that ‘agile’ is the preferred method – leading to show and tell sessions we can attend following every two week ‘sprint’ where we can see the progress that is being made and provide feedback. There are ‘scrum teams’, ‘stand ups’ (brief functional meetings where comedy is not usually a feature), ‘tickets’ and some new acronyms: UX (user experience), UAT (user assessment testing), SMEs (subject matter experts). We talk of ‘SOS’ when we mean ‘Scrum of Scrums’, we document almost every breath in ‘Confluence’, and every task in ‘Jira’. None of the Cochrane editorial team has used these before but by the end of the project several of the team members could choose either as their specialist subject on a quiz show. We talk about ‘Epics’, by which we don’t mean ‘Gone with the Wind’, ‘stories’ (ditto) and ‘features’ (still ditto). You can complete a feature or story without signing off an epic. Or perhaps it is the other way around. Somewhere back in the distant past lies our comfort zone.

After all these tribulations, we have finally reached the first summit. Cochrane has a brand new Cochrane Library. It looks superficially similar to its predecessor so as not to alarm our frequent users, but with some important enhancements. Our multi-lingual content is easier to find and better presented. This is important. In the past three years we have seen a tripling of the number of people accessing the summaries on Cochrane.org, our own website. This has been almost entirely driven by the increases in use in Francophone and Spanish speaking countries. It is true that if you provide content that is easy to find and in people’s own languages, they will come. The new Cochrane Library incorporates more links between related pieces of content, internally and between the Library and external sites. This includes more links between the bibliographic records in CENTRAL and the reviews in CDSR, and more links from reviews to relevant guidelines. The Cochrane Library now includes content aimed at practising health professionals – Cochrane Clinical Answers - and a federated search of the Epistemonikos platform to identify non-Cochrane systematic reviews. There are other features and functionality available now, including some aimed at ensuring that the Cochrane Library meets the needs of, and links with other developments in the scientific publishing landscape such as Crossref, ORCID, Altmetric, Read Cube and others. Most importantly, there is the promise of many more to follow, including the potential to search by PICO parameters (Population, Intervention, Comparators, Outcomes), and the ability to publish different content types, such as methodological articles, rapid reviews and more varied forms of systematic review, and to package them in different ways customised around the needs of evidence users.

There is no denying that the journey has been harder than we all imagined in 2012. Perhaps that is the underlying message. There is a reason why project management language is now dominated by its technology influences. Nothing is simple when you are building a product that spans being a journal and a knowledge resource, includes current and archive content, multi-lingual text, and a varied collection of databases. If you are planning such a large technology project, my advice is to take 10 deep breaths and ask yourself: do you know everything you need to know? Are you sufficiently clear on your requirements and have you communicated them effectively? What will the implementation effort be, and how much will this distract you from everything else you want to achieve? Study it as hard and in as much detail as you can, and then consider whether to add a nought on to every calculation.

Nonetheless, across the three organisations, committed, skilled groups of people have worked tirelessly to deliver the new Cochrane Library. I am extraordinarily proud of the contributions all of our teams have made, whilst recognising the costs, the sacrifices and pain that the project has incurred. Throughout a long and arduous process, the relationships within and across our organisations have remained positive, cordial and collegiate. We are all pleased with what we have delivered and excited about the next steps. Please visit the Cochrane Library, and send me your feedback. We hope that it will become the ‘home of evidence’ that our ‘Strategy to 2020’ envisaged.

This role is an exciting opportunity to use your experience as a Medical Terminology Manager to make a difference in the field of health care research.

As part of the Cochrane Linked Data team you will have a lead role in developing and maintaining the Cochrane Vocabulary, which includes managing and implementing policies regarding purpose, scope, requirements, concept models, hierarchies and terms for the Cochrane Vocabulary.

You will manage and deliver the quality validation process used in the maintenance of the Cochrane PICO Vocabulary and Ontology.

You will quality check the PICO (Population, Intervention, Comparator, Outcome) meta-data for biomedical research information, coded using controlled vocabularies and terminology sets, including SNOMED CT, RxNorm, MedDRA and WHO ATC. Research information includes systematic reviews, clinical trial reports and randomised control trials.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world. The successful candidate will also have:

Strong communication skills (both written and verbal), good collaboration skills, and the ability to work effectively across teams and organizations in a global (mostly virtual) work environment.

Results-oriented and the ability to deliver on a schedule

Strong analytical and judgment skills including ability to make decisions and manage risk.

Attention to detail

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

If you would like to apply for this position, please send a CV along with a supporting statement, including salary expectations, to recruitment@cochrane.org with Medical Terminology Manager in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the role outlined in the job description using specific examples. Please list your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

ContextIn 2017 Cochrane created eight new Networks of Cochrane Review Groups (CRGs) responsible for the efficient and timely production of high quality systematic reviews that address the research questions that are most important to decision makers. The creation of these thematic Networks provided an exciting opportunity for experts in the field to join Cochrane’s new editorial leadership and help the organization deliver its Strategy to 2020 objectives.

Accountability and ResponsibilityThe Senior Editor is accountable to Cochrane’s Editor in Chief. Upon her/his appointment, the Senior Editor will join the Editorial Board for the Cochrane Library. The Editorial Board will be responsible for supporting the EiC and overseeing development and implementation of editorial strategy, in particular the review production process for Cochrane Reviews, and also monitoring the performance of the Cochrane Library.

Within her/his Network, working with CRG teams and the Associate Editor, the Senior Editor’s main responsibilities are both strategic and operational:

Ensure that the reviews produced and published by the CRGs within the Network are of high quality and meet Cochrane’s standards.

Identify gaps in scope coverage based on (at a minimum) the global burden of diseases, and lead and support prioritization processes within the Network.

Lead and support the identification of shared priorities within the Network.

Support communication between the Network and Cochrane community.

Support innovation in the production of Cochrane systematic reviews and their end use.

Each Senior Editor will be responsible for one Network.

Person specificationThe Senior Editor will possess the seniority and experience that enables her/him to fulfil their roles, preferably with the expertise relevant to an organization such as Cochrane, operating as a not-for-profit charity in the research and publishing sectors.

The Senior Editor should also have experience and expertise in key areas of systematic review production, and in addition should be able to demonstrate:

Strong commitment to Cochrane’s Strategy to 2020, and the importance of high quality, relevant systematic reviews that impact on health care and policy

Ability to support and lead innovation

Ability to commit to being available for one day per week for a three-year period

Desirable attributes:

Relevant content expertise

Past or present experience of being a Co-ordinating Editor of a high performing CRG

Past or present experience of editing systematic reviews

ResourcesThe Senior Editor will receive funding from Cochrane to support their work – scaled at about one day per week of activity.

Senior Editors will be able to draw on support from the Associate Editor allocated to their Network, and from a Methods Support Team. Cochrane’s Central Executive Team (CET) will also seek internal and external opportunities for attracting resources for additional support to the Network.

Term of appointmentThe Senior Editor will be appointed in September 2018. They will serve as members of Cochrane’s Editorial Board for a period of three years, renewable.

Co-ordinating Editors who wish to apply for a Senior Editor’s position within a Network that consists of their CRG, should be prepared to step down from that role for the duration of their appointment.

Recruitment processThis position is open to anyone who meets the requirements described above.

All applications will be reviewed by the Editor in Chief and the Deputy Editor in Chief, who will jointly make the appointment.

We are open to job share applications that describe how the functions will be divided, and how continuity will be achieved. We would also welcome applications from candidates wishing to undertake this role as a part-time secondment from their employer.

The appointment process will consider the need for all aspects of diversity, including those of gender, age, experience, language and geographical location. Cochrane’s Editor in Chief aims to appoint a balanced Editorial Board that includes Senior Editors who possess a wide range of content and methodological expertise.

About Cochrane Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Cochrane is a not-for-profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high-quality, trusted information.

On July 12th at the Wellcome Trust in London, UK, world-leading experts came together to look at evidence, policy and practice in the area of childhood pain.

Clinicians, researchers, funders and policy makers from charities, universities and hospitals discussed the lack of knowledge in this area and shared their collective ambition to increase the quality of evidence in this field.

Professor Christopher Eccleston, Coordinating Editor of the Cochrane Pain, Palliative and Supportive (PaPaS) Review Group, who initiated the event explained, “Four years ago the Cochrane PaPaS Group promised a programme of systematic reviews on the evidence for interventions for adults with chronic pain (both neuropathic and cancer related) and children with chronic pain. The work was supported by the NIHR. We produced 49 systematic reviews in a three year period, 10 of which for children and adolescents with chronic pain. The principal finding from these ten reviews was a distinct lack of evidence, with too few trials in this area. The lack of research in this important field is so striking that we wanted to gather a group of influencers together fast to address this gap in knowledge and think creatively about what the solutions could be.”

Presentations were shared on pain in babies, pharmalogical treatments in chronic pain, pharmalogical treatments for disease related pain and psychological treatments for chronic pain followed by discussions which highlighted the lack of large, high quality trials in this area.

Group discussions reflected;

clinical concerns about how pain is identified and measured in children and how adult measures don’t work for children

how cost effectiveness is used as evidence for decision-making in the absence of other knowledge

the lack of interest in researching old drugs

personalised medicine and how this effects creation of systematic reviews

the suitability of longitudinal studies for this age group (but the challenge of including them in systematic reviews.)

how social media feeds a desire for immediate solutions and responses, but smart phones offer an opportunity to collect data differently

The initiative led by the Cochrane PaPaS Group was funded by NIHR and backed by partners including the European Pain Federation, Wellcome Trust, and Arthritis Research UK.

Co-organiser Systematic reviewer and editorial assistant Dr Emma Fisher from the PaPaS Group, explained, “All the attendees are working in some way to mitigate the lack of data in this field, for some it is a daily challenge - treating young patients, knowing they can’t help them as much as they would like. This is a springboard and just the beginning. As an academic collective we have to focus on taking our recommendations forward.”

Following the event, Cochrane PaPaS are considering next steps, this might be a prioritization series for a journal, or a commentary style piece. They are also hoping to see more funding coming into this area and to continue to advocate for more and better research into chronic pain in children.

After 20 years of stellar contributions to Cochrane, Elaine Beller is shifting her keen focus from biostatistics to bushwalking, and embracing semi-retirement. Last week we caught up with Elaine on the road from outback Birdsville – a leisurely 27 hour drive from her home on Queensland’s Sunshine Coast. Though never one to seek the limelight, she was (after a little encouragement) happy to share some parting thoughts about her time as a prolific and multi-talented Cochrane contributor.

Elaine Beller is widely recognised as having an amazing ability to analyse and explain the most complex of matters and methods - be it through her writing, research, teaching, statistical consulting or training materials. An Associate Professor of Biostatistics at Bond University, she’s worked as a biostatistician for some of Australia’s largest randomised clinical trials (RCTs). Through her research work, she has looked at improving the conduct, analysis and use of RCTs across cardiology, nephrology, oncology and orthopaedics. Add to that over 100 peer-reviewed papers and a host of workshops and training resources on clinical trials methods, systematic reviews and epidemiology, and you have a fraction of her distinguished career outside of the world of Cochrane.

Inside Cochrane, her contributions are similarly substantial. Elaine has been an author and statistician for 11 Cochrane Groups, and is a long-time member of both the Trainers Network and Statistical Methods Group among others. For the past three years she has been the Deputy Co-ordinating Editor of Cochrane Kidney and Transplant (CKT) and also worked closely with Acute Respiratory Infections (ARI) at Bond. With such an expert guiding hand in so many groups, projects and reviews, Elaine’s departure represents a significant loss of knowledge, skills and trademark good humour for her many colleagues and friends across the organisation.

‘I’ve really enjoyed the variety of working for so many different groups and getting to know different disease areas in detail,’ Elaine says. ‘It’s been a difficult decision to step back from my Cochrane commitments but it’s time to spend more concentrated blocks of time on other things. Workwise I’ll still be at Bond developing a new Masters in Evidence Based Practice, supervising my PhD students and getting around to publishing a few unfinished papers. But I’ll also be able to travel a bit more and get to a few more of the folk festivals I’d love to see in different parts of Australia.’

Looking back rather than forward, Elaine was what you might now call an early-adopter when it comes to all things Cochrane. ‘I first heard about systematic reviews when Dave Sackett visited Australia in the late ‘80s,’ she says. ‘He was such an amazing guy and I was fascinated by his ideas. We started looking at systematic reviews in our journal club at the Clinical Trials Centre at Sydney Uni and got to know about Cochrane reviews through that. Before long people started consulting me about the analysis of systematic reviews and it all evolved from there.’

In 2009 Elaine headed to Oxford for a sabbatical at the UK Cochrane Centre and the Centre for Statistics in Medicine, where she had the opportunity to pursue methodological research with Doug Altman. ‘I remember being so nervous the first time I was going to meet ‘The Great Doug Altman’, as I’d heard so much about him,’ Elaine laughs. ‘But of course Doug was just so humble and laid back. He was instrumental in getting me into the quality and methodological side of reviews more so than just statistical consulting, so he really changed the course of my career. I was quite devastated when he passed away recently.’

Elaine’s work with Doug sparked an ongoing interest in looking at and improving the way systematic reviews are written up. She returned to Australia from Oxford to join long-time colleague Paul Glasziou at the Centre for Research in Evidence Based Research at Bond University, and a conversation between the two about several confusing abstracts prompted them to publish a call to arms in JAMA in 2011. In it, they argued abstracts should include the main results in both numbers and words, and that the interpretation of results shouldn’t require statistical knowledge.

‘That was our first methodological paper on abstracts and a lot of interesting work then arose out of that – including the PRISMA for Abstracts checklist that now gives authors a framework and guidance to present systematic reviews in a way that meets the needs of different readers. There’s still a long way to go, but we have seen some progress in the overall quality of abstracts – particularly Cochrane abstracts. I do think we should just have one abstract rather than a technical and a plain English abstract. The problem is that authors often assume readers have the necessary technical knowledge to understand what are often badly written technical abstracts, but as the research consistently shows even experienced clinicians often don’t understand them. I’m working on another paper in this area so hope to have a little more time to get that published before too long.’

Elaine’s many contributions to this and other important areas have been much valued within Cochrane and beyond, bringing as she does an unusual depth of knowledge across statistics, methods and the written word – areas that few people understand when taken together. Her skills and accessible approach will be greatly missed. Before wrapping up our interview and getting back to the first of many intrepid adventures of semi-retirement, Elaine offered some sage advice for future contributors.

‘Getting involved in a systematic review as an author is a great thing, but at first just get involved as an author - not as a lead author,’ she concludes. ‘I see a lot of students take on a systematic review as a lead author and really struggle. So I think it’s better to come in as an author with an experienced lead before you take on your own. Overall, I just have to say that Cochrane is an incredible organisation that’s worth belonging to and getting involved with, because what you will learn and take out of it is just amazing.’

Cochrane is pleased to announce that the Cochrane Library, which provides high-quality, independently produced evidence to inform healthcare decision-making, has been redesigned and enhanced to improve user experience and functionality.

Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane contributors and groups produce high-quality systematic reviews, which collate and summarize the best available evidence on the effects of interventions, to inform decisions about health. Cochrane Reviews are recognized internationally as representing a gold standard for high-quality, trusted information, and are published in the Cochrane Database of Systematic Reviews, one of the databases within the Cochrane Library.

The new online platform, designed in collaboration with Cochrane’s publisher Wiley and built by the technology platform provider HighWire, includes several features that will improve the user experience for people whose preferred language is not English, including improved visibility of non-English content, a new Spanish language homepage, and the ability to search in different languages. The new Cochrane Library also delivers a series of improved design features and functionality and allows users to search across varying content types, including Cochrane Reviews and Protocols, CENTRAL trials reports, Cochrane Clinical Answers, Editorials, Special Collections, and other systematic reviews from Epistemonikos, a collaborative, multilingual database of health evidence.

Cochrane’s Editor in Chief, David Tovey warmly welcomed today’s launch: “I am delighted to see the launch of our newly designed Cochrane Library today. This complex project has been all about improving user experience; we have ambitious plans for future development of the Cochrane Library and these can only be delivered by this move to a new and more flexible platform. With this launch, users will immediately notice a richer experience, but we see this is as merely the start of our journey.”

Wiley’s Editorial Director, Deborah Pentesco-Murphy added: “We are delighted that Wiley are able to offer Cochrane’s gold standard Evidence, including the Cochrane Clinical Answers Database, on a new multi-lingual platform, including a Spanish interface, to serve our global audience of users better and with an improved ability to quickly locate relevant information to make informed health decisions. ”

HighWire CEO, Dan Filby, said, “The Cochrane Library is globally recognized for publishing world leading research. We are proud to deliver a user experience for Cochrane that reflects the high quality of content; improving discoverability to help users in their research.”

About Cochrane Reviews Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care. Cochrane Systematic Reviews investigate the effects of interventions for disease prevention, treatment, and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. Cochrane Library is published by Wiley.

About Wiley Wiley, a global research and learning company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 210 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com

About HighWire HighWire is the technology partner of choice for world-leading commercial and academic publishers. With offices globally, HighWire provides digital publishing solutions and platform expertise across all aspects of the publishing life cycle, including content management and hosting, e-commerce, analytics, access and identity management, manuscript submission and tracking. HighWire also delivers strategic consulting services for system and application development, and improving the customer experience.

"It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

An international team, supported by Cochrane Bone, Joint & Muscle Trauma, assessed whether fall-prevention strategies that target two or more risk factors for falls are effective in preventing falls in older people living in the community.

As people age they are more likely to fall. Although most fall-related injuries are minor, they can cause significant pain and discomfort, affect a person's confidence and lead to a loss of independence. Some falls can cause serious long-term health problems. A combination of factors increases the risk of falls with ageing, such as weak muscles, stiff joints, hearing problems, changes in sight, side effects of medications, tiredness or confusion. Poor lighting, slippery or uneven surfaces, and issues with poor footwear can also increase the risk of falling.

Different interventions have been developed to help prevent falls in older people. They may involve a single type of intervention, such as exercise to increase muscle strength, or combinations of interventions, such as exercise and adjustment of a person's medication. A combination of two or more components can be delivered as either a multifactorial intervention based on an assessment of a person's risk factors for falling or as a multiple component intervention where the same combination of interventions is provided to all participants.

The lead author of the review, Dr Sally Hopewell, explains, "This review is an important update for anyone with an interest in falls in older people. It provides useful information on the benefits and risks associated with both multifactorial and multiple component interventions. The growing use of these more complex types of intervention for preventing falls reflect the theory that multiple risk factors are at play, and that these risk factor profiles vary between people. It is crucial that people have an understanding of what interventions work in what populations so as to make correct clinical and policy practice related decisions.”

The team identified 43 trials that compared multifactorial interventions with an inactive control group. They concluded that multifactorial interventions led to some reduction in the rate at which people fall but not the number of people who experienced one or more falls (fallers); however, the quality of the evidence was low. They identified 17 trials that looked at multiple component interventions and concluded they probably reduce the rate at which people fall and the number of fallers compared with the inactive control group.

The review includes 62 randomised trials involving 19,935 older participants living in the community.

Cochrane is pleased to announce plans to establish a new, open and collaborative Network within the US.

An internal review of Cochrane’s structures carried out in 2016 highlighted that a single Center approach for a country the size of the US has many limitations, and that a Network of multiple groups based across the country is a better model to deliver a wider range and expanded scale of Cochrane activities, share collaboration across and between institutions, and create greater impact of that work in diverse regions and different contexts.

There is a sophisticated and well-developed health evidence landscape in the US, and while Cochrane evidence is well known and widely respected, we believe we can do more and better. The Cochrane US Network primary functions will be around ensuring that Cochrane’s evidence is increasingly used in policy and practice inside the US; supporting the Cochrane community of volunteers (authors, methodologists, editors) in the US; and promoting and representing Cochrane in the country.

In the coming months, we will consult widely with a range of stakeholders to develop the strategy and focus of this new Cochrane Network:

This will include:

An open meeting to be held during the Cochrane Colloquium in Edinburgh, on Tuesday 18th September, from 07.30-08.45;

A two-day strategic planning meeting (by invitation) to be held on 29th-30th October in Fort Worth, Texas.

Following these consultative meetings, a call for ‘Expressions of Interest’ will be issued that allows institutions in the US to express their interest to become a member of the Cochrane US Network.

The responsibility for leading the establishment of the new Cochrane US Network is being taken by Cochrane’s Chief Executive Office, but the process is advised and fully supported by the existing Cochrane US West Associate Centre based at the Oregon Health & Science University (OHSU, Portland, Oregon), and the consultation meeting in October is to be hosted by the Texas Christian University.

It is expected that a formal launch of Cochrane’s US Network will take place in early 2019.

For more information of Cochrane’s US Network, and sharing suggestions and information that promote Cochrane’s work across the US, please contact Sylvia de Haan, Senior Advisor (Centres, Partnerships and Fundraising), Cochrane.

Leading institutions, including Cochrane, sign on to international platform which aims to accelerate medical research

The nonprofit organization Vivli launched a novel data-sharing and analytics platform to help researchers move faster toward new treatments and cures. This innovative platform makes it easy for researchers worldwide to discover, share and analyze data from clinical trials, regardless of who sponsored the research or where the research took place.

The Vivli platform launches at a crucial time in the evolution of science. Increasingly, researchers are being required to make their data openly available. New guidelines issued this month by the International Committee of Medical Journal Editors demand that researchers share the data underlying their published results. Government and non-profit research funders are stipulating data-sharing as a condition of their grants. The culture within industry is also shifting to reward more open sharing of data. The Vivli platform boosts these emergent data-sharing efforts by bringing data from all clinical trials together in one place.

“To this day, much of the world’s clinical trial data is not shared, and even when it is shared, it is not integrated across the entire clinical research ecosystem,” said Vivli’s Executive Director Rebecca Li, PhD. “Vivli acts as bridge, enabling researchers of every stripe across the world to build upon each other’s work and speed up science.”

Vivli provides researchers with a secure, easy-to-use online platform to store and share clinical trial data across all diseases, nations and research entities. Vivli also allows researchers to freely combine and analyze data from multiple trials using state of the art tools. This means researchers can validate research findings—from confirming a treatment’s safety to identifying side effects—and avoid duplicative studies, thus reducing costs and shielding research participants from unnecessary risks. The data can also be combined to ask new research questions, such as how a disease evolves over time, and gain information to inform the design of future studies.

Vivli evolved from a project at the Harvard policy center, The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital to enhance access to clinical trials data. For five years, a group of volunteers embarked on a mission to define, design and launch a global solution for sharing clinical trial data. “Sharing clinical trial data is critical in order to move science forward. We owe nothing less to the people who put themselves at risk by participating in these studies that benefit us all,” said Li.

The Vivli platform was built with grants from the Doris Duke Charitable Foundation, the Laura and John Arnold Foundation and the Leona M. and Harry B. Helmsley Charitable Trust. The platform is powered by Microsoft.

About Vivli

Vivli is a non-profit organization working to advance human health through the insights and discoveries gained by sharing and analyzing data. It is home to an independent global data-sharing and analytics platform which serves all elements of the international research community. The platform includes a data repository, in-depth search engine and cloud-based analytics, and harmonizes governance, policy and processes to make sharing data easier. Vivli acts as a neutral broker between data contributor and data user and the wider data sharing community. For more information, visit www.vivli.org and follow us on Twitter @VivliCenter.

They are looking for a dynamic and enthusiastic individual with excellent communication skills to support the production of systematic reviews in the field of wound care.

You will be a graduate with a strong health information background. A qualification in librarianship, information science or equivalent experience is essential.

Experience of designing and conducting online literature searches of databases such as MEDLINE, good computer literacy and a sound knowledge of medical terminology and systematic reviews are also essential.

You will have excellent interpersonal, time management and organisational skills and be able to work with considerable autonomy to regular deadlines.

As an equal opportunities employer we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.

A familiar voice to millions, Dr Norman Swan is one of the English-speaking world's best known health reporters. This week he’s on the other side of the microphone. Norman joins host Ray Moynihan to talk frankly about medicine and the media. He shares some of the joys and challenges of his work inside and outside of the Australian national broadcaster - including his stint as resident medic on commercial TV show The Biggest Loser and his work founding a private media company that advertises inside health clinics across Australia. A multi-award winning journalist and now popular podcaster with a global audience, the common thread running through Norman Swan's distinguished career is a life-long interest in bringing new ideas, information and evidence to audiences of all kinds.

This review team from the Netherlands set out to see if they could find evidence that therapy based on music improves the emotional well-being and quality of life of people with dementia. They were also interested in evidence about effects on emotional, behavioural, social or cognitive (e.g. thinking and remembering) problems in people with dementia.

The team found 22 trials to include in the review and were able to combine results for at least some outcomes from 890 people. All of the people in the trials stayed in nursing homes or hospitals. Some trials compared music-based treatments with usual care, and some compared them with other activities, such as cooking or painting. The quality of the trials and how well they were reported varied, and this affected the confidence in the results.

Lead author Jenny van der Steen, explains, "First, we looked at outcomes immediately after a course of therapy ended. From our results, we could be moderately confident that music-based therapy improves symptoms of depression and overall behavioural problems, but not specifically agitated or aggressive behaviour. Music-based therapy may also have little or no effect on cognition, but we were less confident about this result. We were also not that confident about whether the therapy improves anxiety and emotional well-being including quality of life and we had very little confidence in possible beneficial effects on social interaction.

Jenny continues, “Some studies also looked to see whether there were any lasting effects four weeks or more after treatment ended. However, there was little data and we were uncertain or very uncertain about the results. Further trials are likely to have a significant impact on what we know about the effects of music-based treatments for people with dementia, so continuing research is important. We need high-quality research with blinded outcome assessment to not overestimate effects.”

In summary:Providing people with dementia who are in institutional care with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms and improves overall behavioural problems at the end of treatment. It may also improve emotional well-being and quality of life and reduce anxiety, but may have little or no effect on agitation or aggression or on cognition. We are uncertain about effects on social behaviour and about long-term effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Build up of ear wax is common. It can be uncomfortable for the patient and can cause hearing problems. Ear drops have been studied as a potential tool to soften the wax, preventing the need for further treatment such as syringing. This new review, produced by a team from the UK and US as part of Cochrane Ear, Nose and Throat, looks at which treatment (oil- and water-based drops or sprays) can help resolve wax build up.

other active comparators (e.g. saline or water alone) and no treatment.

Key results: Only one study compared using drops with an active ingredient to not using drops at all. The drops may help increase the proportion of ears cleared of wax from 1 in 20 (if you do nothing) to about 1 in 5 (if you use drops).

The authors did not find any evidence that water-based or oil-based drops were any different to saline or water. However, we also did not find any evidence that water or saline were better than doing nothing.

Adverse (side) effects were not common. Fewer than 30 patients reported any adverse events when using the drops and these were mild (such as slight irritation or pain, or unpleasant smell). No serious side effects were reported by any participant.

Quality of the evidence: For wax clearance, we rated the quality of the evidence as low. For adverse effects we rated the quality of the evidence as low.

Professor Martin Burton, joint Co-ordinating Editor of Cochrane ENT said, “Many people use ear drops when they want to soften or remove wax from their ears. There’s not much high quality, scientific evidence out there to help people decide which to use. But what there is, suggests that using any sort of drops is better than nothing. When it comes to the choice of drops, there are various chemical-containing preparations sold over-the-counter for this purpose. This study shows that they aren’t necessarily any better than plain or salty water.”

The Department of Anesthesiology, Pharmacology & Therapeutics at the University of British Columbia in Canada seeks applications for a full-time Research Associate in the Therapeutics Section.

The successful candidate will lead and conduct a complex systematic review, synthesizing research evidence on the effects of regulatory safety advisories on prescribing, medicine use, and health outcomes. The candidate will also conduct related analyses and contribute tok nowledge translation for multiple projects at the Therapeutics Initiative within the Therapeutics Section of the Department.

The candidate will hold a graduate degree (Ph.D. preferred) in a health sciences discipline and have a minimum of 5 years of experience conducting systematic reviews.

New evidence published today in the Cochrane Library shows that there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death. Below is a Science Media Centre roundup of third-party expert reaction to this review.

“Although diet plays an important role in preventing heart disease, this is complex and unlikely to relate much to any single element of the diet. In addition, it is hard to know whether the effects of diet are due directly to what someone actually eats, or other influences such as income.

“Previous experience has shown that although some types of diet are linked to lower risk of heart disease, when we try to identify the beneficial element of the diet and give it as a supplement it generally has little or no benefit. This was the case for vitamins; we know a diet rich in vitamins is associated with lower risk of heart disease, but studies giving people vitamin pills showed that these gave no benefit and indeed may have caused harm.

“This analysis of many studies shows clearly that omega-3 supplements do not reduce heart disease. This is in keeping with medical practice; although there was a period where people who had suffered a heart attack were prescribed these on the NHS, this stopped some years ago. Such supplements come with a significant cost, so my advice to anyone buying them in the hope that they reduce the risk of heart disease, I’d advise them to spend their money on vegetables instead.”

“This is a high-quality, comprehensive analysis of all the best available evidence from human intervention studies on the supposedly protective effects of omega 3 fatty acids from fish and some plant foods against cardiovascular disease. The results show little or no evidence for important beneficial effects. Given the strong evidence from previous epidemiological studies this conclusion is somewhat surprising, but it needs to be taken seriously. Either the protective effects of oily fish consumption that are observed in populations are due to mechanisms that cannot be reproduced by relatively short-term interventions with purified omega 3 supplements, or perhaps they are caused by other unidentified environmental factors somehow linked to oily fish consumption.”

“The major limitation of this review of randomised controlled trials is that it has been unable to allow for the increased intakes of omega-3 fatty acids over the past 20 years. This has occurred because the food industry recognised the need to redress the balance between omega-6 and omega-3 fatty acids in oils used in food processing as well as ceasing to partially hydrogenate vegetable oils such as rapeseed and soybean oil, which destroyed alpha linolenic acid. The increased use of unhydrogenated canola (rapeseed oil) and soybean oil in processed food has resulted in higher intakes of linolenic acid than in the past.

“Most of the trials in this review were in patients with pre-existing cardiovascular disease (CVD), which is a further limitation when extrapolating to the prevention of heart attacks in the general population. This is important as a substantial proportion of first heart attacks are fatal (it is worth noting that this proportion has fallen greatly in the past twenty years). Previous observational cohort studies, not looked at here, suggest that omega-3 fatty acids may reduce the risk of sudden cardiac death. This outcome can only be studied in a primary prevention trial (that is among individuals who have not had a cardiovascular event).

“The data from previous observational cohort studies, which this review doesn’t take into account, suggest a threshold intake where intakes below 1g/d of alpha linolenic acid are associated with increased risk of fatal heart disease. It follows, therefore, that intakes above this level are unlikely to have any further benefit. Because a small amount of an essential nutrient is needed, it does not follow that more is always better.

“Fish consumption is more consistently associated with reduced risk of cardiovascular disease, again in previous observational studies. Oily fish (sardines, mackerel, salmon) are the main source of long-chain omega-3 fatty acids (eicosapentaenoic, docosapentaenoic and docosahexaenoic acid). These fatty acids are made by marine algae and accumulate in the tissues of fish, particularly oil fish. These long-chain omega-3 fatty acids have different physiological effects from alpha-linolenic acid (lowering blood pressure, decreasing serum triglycerides and reducing the inflammatory response) but these are only seen clearly at high intakes usually in excess of 3g/d, which is generally much higher than the amounts used in the trials (which is typically 1g/d). The recent trials show no benefit of omega-3 supplements in patients with cardiovascular disease who are treated with drugs such as statins, aspirin, and blood pressure lowering medication. However, there may still be a role for omega-3 fatty acids in patients with heart failure, which is still under investigation. Current dietary guidelines to prevent cardiovascular disease encourage fish consumption (two portions of fish a week of which one should be oily) – that would supply in the range of 0.2-0.4 g/d long-chain omega-3 fatty acids – rather than taking supplements. This study provides no evidence to suggest that this dietary advice should change.”

The Science Media Centre is an independent venture working to promote the voices, stories and views from the scientific community to the news media when science is in the headlines. Over 100 supporters including scientific institutions, media groups, charities, universities and corporate organisations provide a donation to support the Centre achieving its objectives. The SMC makes all organisational and editorial decisions independently of funders. This press release contains the personal opinions of those acknowledged, and represents neither the views of the SMC nor any other organisation unless specifically stated.

The Science Media Centre can also help you find an expert on a topical area of science, we have over 2000 media friendly scientists and engineers on our database and you can call us on 020 7611 8300 if you need an expert to interview.

The SMC has asked the experts in the above Roundup to declare any interests which may be regarded by a reasonable and objective third party as giving rise to a conflict, and their responses are included above.

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Omega 3 is a type of fat. Small amounts of omega 3 fats are essential for good health, and they can be found in the food that we eat. The main types of omega 3 fatty acids are; alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is normally found in fats from plant foods, such as nuts and seeds (walnuts and rapeseed are rich sources). EPA and DHA, collectively called long chain omega 3 fats, are naturally found in fatty fish, such as salmon and fish oils including cod liver oil.

Increased consumption of omega 3 fats is widely promoted globally because of a common belief that that it will protect against heart disease. There is more than one possible mechanism for how they might help prevent heart disease, including reducing blood pressure or reducing cholesterol. Omega 3 fats are readily available as over-the-counter supplements and they are widely bought and used.

A new Cochrane systematic review, published today in the Cochrane Library, combines the results of seventy-nine randomised trials involving 112,059 people. These studies assessed effects of consuming additional omega 3 fat, compared to usual or lower omega 3, on diseases of the heart and circulation. Twenty-five studies were assessed as highly trustworthy because they were well designed and conducted.

The studies recruited men and women, some healthy and others with existing illnesses from North America, Europe, Australia and Asia. Participants were randomly assigned to increase their omega 3 fats or to maintain their usual intake of fat for at least a year. Most studies investigated the impact of giving a long-chain omega 3 supplement in a capsule form and compared it to a dummy pill. Only a few assessed whole fish intake. Most ALA trials added omega 3 fats to foods such as margarine and gave these enriched foods, or naturally ALA-rich foods such as walnuts, to people in the intervention groups, and usual (non-enriched) foods to other participants.

The Cochrane researchers found that increasing long-chain omega 3 provides little if any benefit on most outcomes that they looked at. They found high certainty evidence that long-chain omega 3 fats had little or no meaningful effect on the risk of death from any cause. The risk of death from any cause was 8.8% in people who had increased their intake of omega 3 fats, compared with 9% in people in the control groups.

They also found that taking more long-chain omega 3 fats (including EPA and DHA), primarily through supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities. Long-chain omega 3 fats probably did reduce some blood fats, triglycerides and HDL cholesterol. Reducing triglycerides is likely to be protective of heart diseases, but reducing HDL has the opposite effect. The researchers collected information on harms from the studies, but information on bleeding and blood clots was very limited.

The systematic review suggests that eating more ALA through food or supplements probably has little or no effect on cardiovascular deaths or deaths from any cause. However, eating more ALA probably reduces the risk of heart irregularities from 3.3 to 2.6%. The review team found that reductions in cardiovascular events with ALA were so small that about 1000 people would need to increase consumption of ALA for one of them to benefit. Similar results were found for cardiovascular death. They did not find enough data from the studies to be able to measure the risk of bleeding or blood clots from using ALA.

Cochrane lead author, Dr. Lee Hooper from the University of East Anglia, UK said: “We can be confident in the findings of this review which go against the popular belief that long-chain omega 3 supplements protect the heart. This large systematic review included information from many thousands of people over long periods. Despite all this information, we don’t see protective effects.

“The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause. The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts.

“This systematic review did find moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation. However, the effect is very small, 143 people would need to increase their ALA intake to prevent one person developing arrhythmia. One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event. ALA is an essential fatty acid, an important part of a balanced diet, and increasing intakes may be slightly beneficial for prevention or treatment of cardiovascular disease."

About Cochrane Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information. Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About UEAThe University of East Anglia (UEA) is a UK Top 15 university. Known for its world-leading research and outstanding student experience, it was awarded Gold in the Teaching Excellence Framework and is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk.

Find out more about what we have planned for the 2018 Colloquium in Edinburgh

Cochrane UK is delighted to be hosting the 25th Cochrane Colloquium, at the Edinburgh International Conference Centre in Scotland, from 16th to 18th September 2018.

We have given the Colloquium the title ‘Cochrane for all – better evidence for better health decisions’. This is to emphasize that Cochrane welcomes everyone and recognizes that everything Cochrane does is about and for patients and other health consumers. The Colloquium in 2018 is an event that is co-designed, co-produced and co-presented with healthcare consumers; an event where everyone’s input is valued equally.

We have been asked about this particular focus. We believe passionately that we all share the same goal: better health for patients, healthcare consumers and the world at large.

The Colloquium will be in Edinburgh, the capital city of Scotland, ‘Auld Reekie’ to the Scots. With its medieval and classic architecture built on the side of an extinct volcano, and its Castle visible from most corners of the city, Edinburgh is best discovered on foot. Wander the narrow passageways and medieval streets winding down from the Castle to join the New Town, and stroll through the gardens that now flourish where once a moat surrounded the Old Town. If walking isn’t for you, there are bus tours of the sights and the city is well served by public buses and trams. With its blend of old and new, three national art galleries and more bars and restaurants per capita than any other city in the UK, Edinburgh is vibrant and diverse, with much to see and do. If you have a Scottish name, you might even be able to find your clan tartan.